International Journal of Medical Education最新文献

Objectives: To evaluate the impact of enhancing village health volunteers' (VHVs) abilities to promote engaged community-based interprofessional education (CBIPE).

Methods: A single-group pre-posttest design was implemented with 100 VHVs enrolled in a VHVs' abilities program. The program consisted of a two-day workshop that included five key sessions: a 30-40-minute lecture, demonstration and replay, 15-30-minute information sharing and communication, 60-150-minute discussion and practice, and 30-minute feedback. Of the participants, 83 VHVs completed the course and provided data for analysis. Outcomes measured included attitude and motivation towards associate teachers, self-esteem, community diagnosis knowledge, and course satisfaction. Repeated-measures ANOVA was used to analyze changes in competency scales over time.

Results: A significant increase in community diagnosis knowledge was observed post-intervention (mean difference = 26, 95% CI = 24-28; p < 0.001). Significant improvements were also seen in attitude (mean difference = 1.00, 95% CI = 0.96-1.04; p < 0.001), motivation (mean difference = 0.92, 95% CI = 0.86-0.97; p < 0.001), communication (mean difference = 0.95, 95% CI = 0.92-0.97; p < 0.001), and systems thinking (mean difference = 0.98, 95% CI = 0.97-1.00; p < 0.001). No significant change was observed in the active listening scale (p = 0.104). VHVs expressed high satisfaction with the program, with an average score of 4.13 ± 0.76.

Conclusions: VHVs' abilities programs effectively enhance knowledge and improve VHVs' competencies. Ongoing training for associate teachers is essential to support engaged learning and CBIPE field practice for medical students.

Objectives: This study aims to explore the perspectives of standardized patients previously involved in equity-seeking healthcare training simulation activities to better understand how stakeholders can engage and support standardized patients in the delivery of educational opportunities for healthcare professionals related to equity, diversity, and inclusivity.

Methods: A qualitative research study was conducted utilizing semi-structured interviews with persons (N=15) who self-identified as being involved in the development and/or the delivery of simulations related to equity, diversity, and/or inclusion. Participants were recruited via email using internal and public lists for standardized patient programs and through snowball sampling. Interviews were recorded and transcribed verbatim and transcripts were analyzed qualitatively in an iterative coding process, anchored by direct content analysis methodology, and informed by three theoretical perspectives: the standardized patient journey, psychological safety, and empowerment theory.

Results: We constructed three main themes: (1) safety should be prioritized throughout the journey; (2) empowerment is key to engagement; and (3) standardized patient trainers are central connectors for safety and empowerment.

Conclusions: Through the perspectives of standardized patients, this study has provided insight on strategies to engage and support those participating in equity-seeking simulations. Focused attention on safety and empowerment is warranted, with trainers having a critical role in empowering standardized patients to succeed in equity-seeking simulations. Future research should continue to explore best practices surrounding engaging, supporting, and retaining individuals involved in equity-seeking healthcare training, including comprehensive training for trainers on how to ensure, maintain, and restore standardized patients' psychological safety.

Objectives: To explore medical students' self-assessed preparedness for clinical practice and attitudes towards learning communication skills, and attitudes towards patient-centeredness before and after introducing a new curriculum with a group mentorship program.

Methods: A cross-sectional questionnaire-study (1-5 Likert scale) was conducted among the first class of medical students following the new curriculum (NC, n = 51) in their fifth year and the final class of students in the old curriculum (OC, n = 48) in their sixth year. The questionnaire contained questions regarding program evaluation, and statements that measured the students' attitudes towards learning communication skills and patient-centeredness. Descriptive statistics and Mann-Whitney U-test were used.

Results: NC-students (Mdn=4) scored significantly higher than the OC-students (Mdn=3), when asked how they thought the first four years of the medical curriculum had prepared them for clinical practice (U=828.5, p=.003, r=0.35). Similarly, NC-students felt more prepared for communication with patients (Mdn=4 for both groups, U=748.5, p<.001, r=0.35) and ethical reflections (Mdn=4 for both groups, U=951.5, p=0.043, r=0.20). NC-students reported significantly more positive attitudes towards learning communication skills than did OC-students. They had higher mean scores on all items regarding patient-centeredness, although these differences were not statistically significant.

Conclusions: A group-based mentorship program within the new curriculum significantly enhanced medical students' self-assessed clinical preparedness and positively shifted their attitudes towards communication skills and patient-centeredness. More research is needed to compare medical schools with and without longitudinal group mentorship programs to assess students' professional attitudes, and ideally, their performance in clinical practice.

Objectives: This study aims at evaluating the role of Monash Online Simulated Clinical Examination (MONSCE, where students demonstrate their clinical consultation, problem solving and counselling skills in a virtual encounter) in relation to the Observed Structured Clinical Examination (OSCE).  The study addresses feasibility and application, student, tutor and Simulated Patient (SP) acceptance and also assessing future role in student assessment.

Methods: Drawing on social constructivism, the study employed a qualitative methodology to explore perspectives of medical students, examiners and SPs across metropolitan Melbourne, rural Victoria and Malaysia. Data included individual interviews with nine examiners, eleven SPs, and three focus groups with students. Data were transcribed and thematically analysed using framework analysis.

Results: Analysis demonstrated overlapping perspectives with five themes - fit for purpose assessment, focus on dynamics of online discourse, perceiving realism, readiness for practice and implications for future, with ongoing role in Telehealth. Readiness or preparation for practice was acknowledged through impact on student performance for progression, examiners' focus on assessment rigour replicating chaos and complexity of real life and SPs drew analogy with real-life clinical consultations.

Conclusions: MONSCE assessments appear to be useful for student assessment of skills like history taking and clinical counselling. Their role was considered complementary to in-person clinical skills assessment but not replace the complexity of real life or replicate skills assessment of empathy, physical examination, and difficult communication, where in-person assessment may be preferred.

Objectives: To cross-culturally validate the Feedback Orientation Scale in the clinical workplace, focusing on the Spanish adaptation of the instrument in the Chilean context.

Methods: A cross-cultural validation of the Feedback Orientation Scale was conducted across six Chilean universities and nine health professions education programs. The target population were students in their clinical clerkship. The scale was translated through a rigorous process and was applied online. Validity and reliability of the constructs were evaluated through confirmatory factor analysis. A descriptive statistical analysis was conducted.

Results: A total of 510 students participated (70% female, average age 24.1 years, 30% response rate). Students' responses were from Medicine (n=128), Physiotherapy (n=128), Nursing (n=63), Dentistry (n=49), and five other disciplines. Confirmatory factor analysis showed a sufficient fit of the original factor structure CFI = 0.96, SRMR = 0.045, RMSEA = 0.051, 90% CI [0.044, 0.057]. Item loadings were above 0.50. Factor reliability ranged from 0.77 to 0.91. Overall, students' perception of receptivity to feedback was positive, and the Feedback Self-efficacy subscale had the most "disagree" and "strongly disagree" responses.

Conclusions: Our findings provide evidence regarding the validity and reliability of the Feedback Orientation Scale for assessing the feedback orientation of health profession education students in the clinical workplace. Students scored lowest on two items related to feedback self-efficacy, indicating low confidence in handling feedback. This Feedback Orientation Scale can reveal valuable insights into how students may differ in their receptivity and use of feedback in the clinical workplace, informing teaching practices and interventions, and redesigning existing feedback practices.

Objectives: The aim of this study was to create a new integrated competency framework for the postgraduate training in obstetrics and gynaecology and to reach consensus through a Delphi study.

Methods: Using the Canadian Medical Education Directives for Specialists (CanMEDS) framework as a basis, three existing frameworks were merged by screening for keywords. Subsequently, consensus on the unified framework was reached through a Delphi study: a group of 18 Belgian experts was asked for their opinions on the competencies through three successive questionnaires.

Results: In the first round, one of the in total 91 competencies was deemed irrelevant. In the second round, the competencies were reviewed for content and formulation, after which consensus was not reached on 15 competencies. These 15 competencies were adjusted as needed based on comments collected during the first two rounds. The adjusted competencies were then sent back to the experts in the third round, resulting in a final consensus on all 91 competencies. However, the comments indicated that several competencies were considered broad or vague, casting doubt on their practical applicability.

Conclusions: Through a Delphi study, consensus was reached on a newly composed competency framework. Such a holistic competency framework can form the basis of a curriculum reform in the postgraduate training in obstetrics and gynaecology within Belgium, but also in a more international context. Further research is needed to develop an assessment tool to implement these competencies in practice.

Objectives: This study was aimed at improving clarity regarding the goals underlying motivation for attendance at international meetings to accommodate evolving needs.

Methods: We performed a case study of a large international medical conference by undertaking (a) semi-structured interviews with 13 multi-disciplinary stakeholders, which underwent thematic analysis, and (b) surveys of 1229 conference attendees, which underwent descriptive statistical analysis and directed content analysis.

Results: Interviews suggested scientific updates and networking are priorities for in-person formats whereas flexibility and reduced travel are priorities for virtual formats. Surveys suggested motivations for attending both in-person and virtual conferences included: scientific updates (81.3% and 85.4%, respectively) and advancements in patient care (76.6%, 78.2%). Social interaction (e.g., to meet experts 80.6% and make/deepen professional connections 69.3%) was highly rated for in-person meetings, but not virtual meetings (51.0% and 30.8%, respectively). 58.9% of attendees prefer future meetings to be hybrid, including both in-person and virtual formats.

Conclusions: We found a disconnect between attendees' preferences and recommendations currently put forward as socially responsible in terms of climate, equity and diversity. Meeting organisers may need to educate others about the value and costs involved in hybrid formats. When hybrid formats are possible, our data provide guidance on what to prioritize during in-person components and how to combine those with the benefits of global accessibility and flexibility enabled by virtual technology.

Objectives: We aimed to determine if shared decision-making (SDM) self-assessment of a standardized patient (SP) scenario was reliable, specifically whether students' communication resulted in each SP-student pair reporting internally consistent final treatment choices. We hypothesized student self-assessment would differ from SP and faculty assessment indicating a need for multisource feedback.

Methods: In this observational case study from 2016-2017, all third-year post-clerkship medical students received evidence-based treatment options for sinusitis and SDM lectures followed by a SP encounter on sinusitis. Students, faculty, and SPs then completed a 9-question assessment covering SDM skills, perceived empathy, and final treatment choice. Mean self-assessment was compared to faculty and SP scores using paired t-test. Effectiveness of SDM communication was assessed as rate of treatment agreement, defined as percent of student-SP pairs reporting consistent final treatment choices.

Results: Compared to SPs (M = 23.4, SD = 3.6), 120 students (M = 22.6, SD = 3.1) reported lower mean SDM skills, t₍₁₁₉₎ = 2.25, p = .027. Conversely, SPs (M = 8.0, SD = 1.5) compared to students (M = 8.5, SD = 1.1) reported lower mean empathy, t₍₁₁₉₎ = 3.43, p < .001.  Faculty ratings of students' SDM (M = 22.7, SD = 3.5) and empathy (M = 8.3, SD = 1.7) was not statistically different than students' ratings, t₍₁₁₉₎ = 0.46, p = .645 and t₍₁₁₉₎ = 1.40, p = .164 respectively. Seventeen (14%) student-SP pairs reported different final treatment choices.

Conclusions: We demonstrated the limitations of self-perception of SDM and empathy skills, highlighting the importance of multisource feedback for assessing trainee communication skills. Disagreement between student-SP pairs on perceived final treatment choice underscores the need for ongoing SDM practice.

Objectives: To explore association between perceived stress and psychological distress (depressive symptoms and anxiety), and the stress-buffering effects of social support (parents, partners, friends, peers, teachers, social media), sense of community belonging and meaningfulness of studying.

Methods: A cross-sectional study was conducted in 2018 using a convenience sample of 800 healthcare students from the University of Helsinki, Finland. Participants completed an online survey. Logistic regression analyses were performed using the PROCESS Macro to explore the relationship between perceived stress and psychological distress, and the moderator effects.

Results: Perceived stress was associated with depressive symptoms and anxiety. Perceived stress had significant interactions with parent (B =-.03, t₍₇₈₃₎ = -2.4, p < .001), partner (B = -.05, t₍₇₈₃₎ = -4.3, p < .001) and peer support (B=-.04, t₍₇₈₃₎ = -3.0, p < .001), sense of community belonging (B=-.06, t₍₇₈₃₎ = -2.7, p < .01) and meaningfulness of studying (B=-.12, t₍₇₈₃₎ = -4.5, p < .001) in predicting depressive symptoms, and with parent (B = -.05, t₍₇₈₃₎= -3.8, p < .001), partner (B = -.03, t₍₇₈₃₎ = -2.2, p < .05) and peer support (B=-.05, t₍₇₈₃₎ =-3.5, p < .001), sense of community belonging (B=-.05, t₍₇₈₃₎=-2.5, p < .01) and meaningfulness of studying (B = -.08, t₍₇₈₃₎ = -3.0, p < .01) in predicting anxiety. Perceived stress had weaker effects on depressive symptoms and anxiety at higher levels of support, sense of community belonging and meaningfulness of studying.

Conclusions: Support from parents, romantic partners and peers, sense of community belonging and meaningfulness of studying may buffer the negative psychological outcomes of perceived stress. Promoting social support, sense of community and the meaningfulness of studying can help prevent psychological distress in healthcare students. Longitudinal research and further investigation on factors related to sense of community belonging and meaningfulness of studying are warranted.